Florida\u2019s 5 million Medicare enrollees will see significant changes in 2026 to premiums, deductibles and choices in plans.<\/p>\n
\u201cYou are going to need to pay close attention to your annual notice of change,\u201d said Jenny Chumbley Hogue, a health insurance expert and contributor for medicareresources.org.<\/p>\n
In Florida, like many other markets, Medicare Advantage plans are shrinking, shifting and exiting pockets of the state. Some existing Medicare Advantage plans may not be available next year, have higher premiums, or cover fewer doctors, hospitals, and pharmacies.<\/p>\n
\u201cIf a doctor or other provider is important to you, do not rely on online directories,\u201d Chumbly Hogue said. \u201cCall and ask which plans they are participating in for 2026.\u201d<\/p>\n
In Broward County, SHINE liaison Gloria Ayan said many enrollees in Cigna and AvMed have received notice that their plans will not be available in 2026. Other individuals have received notification that their hospital system and the physicians affiliated with it are no longer in network. That includes Humana, Care Plus and Florida Blue plans, which are out of network for Memorial Healthcare System. The changes are creating a demand for guidance from SHINE<\/a>, which provides free assistance to Medicare beneficiaries.<\/p>\n \u201cWe had 254 calls last month alone,\u201d Ayan said.<\/p>\n While switching plans can seem like a hassle, this enrollment period<\/a> presents an opportunity to find a plan with better benefits that meet your needs.<\/p>\n Hospital coverage is a key factor to consider in making your choice. Some Medicare Advantage plans are raising the total out-of-pocket costs for inpatient care at hospitals or increasing the co-pays for hospital stays.<\/p>\n \u201cYou don\u2019t want it to be a surprise if your hospital co-pay increases $75 a day and you\u2019re in the hospital for four days,\u201d said Louise Norris, a health policy analyst for medicareresources.org<\/a>.\u00a0 \u201cThat\u2019s not something you want to find out when you go to the hospital.\u201d<\/p>\n To lure new members, Medicare Advantage plans often offer perks such as grocery cards, transportation to medical appointments, and fitness programs. In 2026, some plans cap spending on these benefits or reduce their offerings.<\/p>\n \u201cYou really need to shop around during open enrollment,\u201d Norris said.<\/p>\n Dental and vision coverage, a benefit offered by some Medicare Advantage plans, may also be less comprehensive in 2026.<\/p>\n \u201cPlans this year may have dollar limits on dental coverage or change their network of dentists covered under their plan,\u201d said Tricia Neuman, executive director for KFF\u2019s Program on Medicare Policy. \u201cThat could affect how much someone spends on dental care, but it\u2019s hard to assess during open enrollment. You have to dig deep into the materials to see what is covered and what the limits are to project your future spending.\u201d<\/p>\n Original Medicare premiums rising<\/p>\n For those enrolled in Original Medicare, you will find changes for 2026, particularly in your costs.<\/p>\n Expect a projected double-digit increase in Medicare Part B premiums, an 11.6% rise to $206.50 per month.<\/p>\n \u201cPremiums are based on spending, so as spending rises, premiums have gone up,\u201d said Neuman of KFF, a health policy research organization.<\/p>\n Despite the increase, Neuman said, \u201cIt\u2019s important to think of the tradeoffs and assess the ways Medicare Advantage plans vary and whether you should switch to traditional if you are dissatisfied. With traditional, you can see any doctor anywhere in the country, and you don\u2019t need prior authorization.\u201d<\/p>\n Drug plans that supplement Original Medicare or Medicare Advantage plans will become more costly in 2026: The maximum out-of-pocket cost for drug plans (also known as Part D) will increase by $100 in 2026. The good news is once you hit the $2,100 cap in 2026 (up from $2,000 in 2025), you\u2019re done paying for covered prescriptions for the year. That\u2019s still a vast improvement compared to past years when there was no maximum limit.<\/p>\n However, costs are still trending upward, so you\u2019ll want to review your drug plan\u2019s formulary closely to calculate the total cost of your medications rather than just looking at the monthly premium.<\/p>\n Medicare will continue to provide free coverage in 2026 for all CDC-recommended adult vaccines \u2014 no deductible, no co-payment. That coverage includes shingles, pneumonia, and flu vaccinations and COVID boosters.<\/p>\n Depending on a person\u2019s income, adjustments are made to premium surcharges for Original Medicare and the drug plan.\u00a0 Anyone who earns above the designated threshold pays a premium surcharge for Medicare.\u00a0 That threshold rises to $109,000 in 2026, an increase of $3,000. It is based on your 2024 tax return, so if your financial situation has changed, there is an appeal process, Norris notes.<\/p>\n Prior authorization changes<\/p>\n One of the most common complaints among seniors is the process of prior authorizations. Some shifts should ease this process: Insurer approvals for inpatient care must last until discharge (no more re-approvals mid-stay); plans must respond within 14 business days; denials must come with a clear, clinical reason; and plan holders who are denied can request an independent external review.<\/p>\n